News background > >
A few days ago, National Health Commission and other five departments formulated the Opinions on Promoting the Development of Clinics. The Opinions put forward innovative reform measures such as encouraging qualified doctors to set up specialist or general clinic full-time or part-time. From 2019 to 2020, 10 cities including Beijing, Shanghai, Shenyang, Nanjing, Hangzhou, Wuhan, Guangzhou, Shenzhen, Chengdu and Xi ‘an will carry out pilot projects to promote the development of clinics, and improve the policies on clinic construction and management according to the pilot experience, and promote them throughout the country. In addition, the Opinions also encourage doctors who have been practicing in medical institutions for five years and obtained intermediate or above titles to set up specialized clinics full-time or part-time. Encourage qualified general practitioners, or specialists with the scope of general practitioners, to set up full-time or part-time general clinics. In addition, the Notice on Optimizing the Inter-departmental Examination and Approval of Social Medical Institutions proposes that the facilities of medical institutions below 300 square meters do not need to go through the formalities of fire protection design and completion acceptance; Medical institutions that have little impact on the environment and do not need environmental impact assessment shall implement environmental impact registration form for filing management. Obviously, for clinics, the pace of national promotion is getting faster and faster.
Reporter survey > >
If the "Opinions" are implemented, many doctors will "go out" of hospitals to open clinics, and ordinary people can find their favorite experts nearby. So, what are the difficulties for doctors to open clinics? Are doctors willing to run private clinics? What is the current clinic market in Xi ‘an?
Xi ‘an currently has a certain number of clinics. In 2018, the statistical briefing on the development of health care in Xi ‘an pointed out that there were 2,242 clinics, health clinics and infirmary in primary health care institutions in Xi ‘an. The reporter visited and found that most of these clinics are in residential areas, some are handed down from generation to generation, some are directly employed after graduating from medical school, and even fewer have more than 5 years of experience in public hospitals. The patients who go to the clinic are mainly migrant workers with strong mobility and incomplete medical insurance coverage.
Clinic case > >
Yuan Lintian and Luo Laning: Nearly 10 million people have borrowed money to invest, and I believe that they will pay back the money sooner or later.
Yuan Lintian used to be a dentist in the Stomatological Hospital of Air Force Military Medical University. Yuan Lintian’s lover, Luo Laning, turned out to be a doctor in the reproductive medicine department of Tang Dou Hospital. After the couple switched jobs, they chose their own jobs and started Yuan Lintian Children’s Stomatological Hospital, one in charge of technology and the other in charge of operation.
"We originally planned the outpatient service with an area of 500 square meters and 6 dental chairs. However, in the process of preparation, it was found that the plan could not meet the high demand of customers for dental care, so the outpatient area increased from 500 square meters to 1100 square meters, and then to 2000 square meters in the stomatological hospital. In order to provide customers with the best technology and services, and constantly acquire the latest equipment, instruments and equipment have also added the latest high-tech products. In this way, I used up all my savings, borrowed several more, and invested nearly 10 million yuan. I didn’t think so much at first, and now I don’t know when I can return the money. However, it is a health industry, and sooner or later the money will be returned. " Luo yanin told reporters that it is really impossible for doctors to open clinics without some economic mind.
Here, Yuan Lintian strongly disagreed. "No matter where you treat people, the professional ethics of doctors must be kept in mind. There is no hurry about making money." In the eyes of his lover, Yuan Lintian said such a thing at the moment, which is the performance of "I don’t know how expensive the rice, oil and salt are".
"The hospital has more than 20 people at the beginning, and now there are more than 70 full-time staff. Every month’s salary, social security, and patients’ fixed consumables, water, electricity, rent, etc. require fixed expenditures of millions. "Luo yanin calculated accounts.
"If I don’t come out of the hospital in the establishment, I will probably be promoted to the top, then I will work for a long time, do scientific research, and finally retire." Yuan Lintian has a new goal-to share his "lifelong learning", so Yuan Lintian’s Stomatological Hospital is not only a specialist clinic, but also a training base. "I went to many private dental clinics to see that their pediatric dental skills are really general, and there are too many needs to be improved. However, doctors have a high threshold for further study and few places, and there are only a few places a year. Most of them are doctors in local basic public institutions. Now I have brought doctors from nearly 200 private dental clinics. How many people will benefit from their studies! "
Li Jun’s family: The Chinese medicine museum entered tens of thousands in the 1990s, but now it is meager profit to open a clinic.
Li Jun is now the director of psychiatric outpatient office of Yanta Ganlu Hospital in Xi ‘an, and once worked in a public hospital in weiyang district, Xi ‘an.
Speaking of doctors’ clinics, Li Jun’s family is the earliest representative of early adopters. Li Jun’s father was a deputy chief physician of traditional Chinese medicine, and worked in several public hospitals successively. Until an accidental opportunity in the 1990s, influenced by the coastal cities of Shenzhen and Guangzhou, Li Jun’s father decided to quit his job and open his own Chinese medicine museum with the encouragement of his wife who worked in the hospital.
This was definitely a rare thing in those days. "After all, it is a golden rice bowl. Who dares to throw it away?" Li Jun said, "At that time, my dad rented a room near the Bell Tower. Next door was a barber shop selling boiler accessories. My dad’s Chinese medicine museum was among them, but it was also fresh."
"Are there many patients in such a simple Chinese medicine museum?" In the face of a reporter’s question, Li Jun said, "From this incident of my dad, I can see that if you want to open a clinic, you must have good medical skills. If you want to have many patients every day, you must have a high reputation." Li Jun’s father has accumulated many patients in his medical career for many years, so a large number of patients came here after opening the clinic.
"Once my dad’s colleagues and friends went to the clinic and saw so many people, they were also moved to give up the golden rice bowl and the whole clinic. However, when I saw that the health fee was entangled with my dad, I immediately retired. " Li Jun mentioned that some people are envious when they see that there are many people in the clinic, but they don’t know that once they start, they need to worry about their own daily business issues, such as industry and commerce, taxation and so on, in addition to lean medical technology.
Li Junjia’s Chinese medicine museum earned tens of thousands of dollars a month in the 1990s, but now, after removing the expenses such as personnel every month, the remaining money is equivalent to the salary of students who work in other medical schools. "Without medical insurance reimbursement, ordinary people don’t come. With medical insurance reimbursement, the profit is much lower. It can cost a lot to open a clinic by yourself." Therefore, Li Jun believes that in the current era of meager profit, doctors have to calculate an account before opening a full-time clinic.
Doctor’s opinion > >
Subject research, promotion of professional titles
Become a stumbling block for doctors to "start a business"
Tian Zhufang, director of endocrinology department of Xi ‘an Central Hospital and leader of endocrinology discipline: There is no end to learning, and I will not come out to open a clinic.
"I am responsible for the development of endocrinology in our hospital, and I am still taking students. I think there is no end to learning, life science is very profound, and there are still many things we need to explore. If I leave the hospital, I think it may be a bit difficult to explore my subject. The people are looking forward to the big experts going to the door to see a doctor, but if the big experts are doing basic health care, will there be no one to overcome the academic difficulties in the future? "
The reporter asked again, is it ok to work part-time? Tian Zhufang added, "I think it is even more impossible to take a part-time job. When I go to the clinic, I see 80 patients for more than a day, and I have to make rounds every day. I also often have multidisciplinary consultations in the hospital and often have academic meetings on weekends. Don’t say part-time, I’m already working at full capacity. "
Some young doctors also said that they would not resign. Xiao Zhang has just been promoted as an attending physician, and many non-public hospitals have extended "olive branches" to him, but he is worried: "If you leave the system and the front line of scientific research, will it be difficult to be promoted in the future?"
Dr. Y, who doesn’t want to be named: The economic pressure is also quite great. I hope to increase some income.
There are also doctors who have revealed their infinite desire for this policy. "Everyone thinks that doctors are a very decent job, but in fact we are also very helpless. Our salary is not as high as the outside world imagined, but the salary assessment is higher than the outside world imagined. The salary that is often sent to our hands is the same." Dr. Y, who didn’t want to reveal his name, said that at most, his salary can make his family basically live normally, because he took his parents to live together. In the first two years, he borrowed money to change a three-bedroom house. The child will take the college entrance examination this year and get married in a few years. In fact, the economic pressure is quite great, and he doesn’t even say that he has opened an outpatient clinic. If he can practice more openly and part-time, he will feel good.
Dean of a 3A hospital in Xi ‘an: High-quality medical resources are scarce. I’m afraid there is no spare capacity for part-time doctors.
A third-class hospital in Xi ‘an has drawn up a statement, mentioning that several well-known experts in the hospital have not been in the outer hospital and other related contents. The fact is that those experts do make house calls outside, once a week for half a day. Then the hospital fixed these experts in the outpatient clinic on weekends. At the time of this incident, the state has issued relevant policies to encourage doctors to practice more. Even if you practice more, opening a clinic part-time is really a "problem" for the managers of large hospitals.
Some people have no choice but to say that some doctors now practice more or open part-time clinics, which seems to be "stealing chickens and touching dogs". It seems that once they are found by hospitals, they will be afraid of "decapitation". In this regard, the dean of a 3A hospital in Xi ‘an said that he is not narrow-minded as a hospital manager, but only considers the development of the hospital. In fact, at present, the overall quality medical resources are scarce, and people’s energy is limited after all, and their work based on our hospital is stretched. How can there be any spare capacity to do part-time jobs?
Mr. Z, a neurosurgeon in a public 3A hospital in Xi ‘an: Treatment requires teams and equipment, which is not that simple.
"I am a surgeon who runs a clinic. I really don’t know what I can do." Mr. Z said, "Western medicine is based on accurate diagnosis, which means that patients have to do a lot of tests. Each piece of equipment is worth tens of millions. How much money do I have to raise to open such a hospital? Moreover, even if the number of patients with different diseases increases year by year, not everyone will get difficult and critical diseases. For example, patients with cerebral hemorrhage are not suitable to come to the hospital during the mild period. If they are found in time through a variety of diagnoses, they can immediately carry out related treatment, regardless of surgical treatment or interventional treatment, they also need teams and equipment. Surgery is inseparable from surgery. There are too many problems such as laminar flow level and disinfection supply in the operating room behind an operation, which is not as simple as I thought. " Speaking of this, Mr. Z also mentioned a more direct problem. If the patient is not rescued in his own hospital, his family will be painful but acceptable. But if you are in the "doctor’s clinic", it is estimated that there may be a "medical trouble".
At present, the "doctor’s clinic" in Xi ‘an is mainly specialized in stomatology, plastic surgery and traditional Chinese medicine.
Through investigation, the reporter found that the most popular "doctor’s clinics" are stomatology, Chinese medicine, orthopedics and plastic surgery. Some doctors said that contrary to the market supply of specialized clinics everywhere, the people’s demand for doctor clinics is more in the field of "general practitioners". General practitioners are generally generalists who deal with common diseases, frequently-occurring diseases and general emergencies in the form of outpatient service. As far as the medical needs of ordinary people are concerned, the general practitioner is actually the key role of basic diagnosis and treatment, and it is also the "doctor’s clinic" that everyone needs to increase most.
The lack of general practitioners or the "pain point" for doctors to open clinics. The "Implementation Plan for Reforming and Improving the Incentive Mechanism for Training and Using General Practitioners in Xi ‘an" was issued at the end of 2018. The "Plan" proposes that by 2020, there will be 2 to 3 qualified general practitioners for every 10,000 residents in urban and rural areas. As far as national big data is concerned, China currently has 1.8 general practitioners per 10,000 residents. Compared with the huge demand, it is far from meeting the daily needs of ordinary people for general practitioners only by policy promotion.
Reporter’s notes > >
As long as medical behavior is standardized and legal, it is worth practicing.
During the interview, the reporter found that there are still many problems that doctors need to understand if they want to open a clinic. Such as "regional health planning" indicators, administrative examination and approval, etc. As far as administrative examination and approval is concerned, the reason why many doctors give up is that the hospital’s "birth permit" is difficult to handle. In fact, the two documents, the Notice on Further Reforming and Perfecting the Examination and Approval of Medical Institutions and Physicians, published in June 2018, and the Notice on Optimizing the Cross-departmental Examination and Approval of Social Medical Institutions, published in January 2019, re-mentioned that the examination and approval and practice registration of medical institutions at level 2 and below are "two certificates in one".
There is also the problem of promotion of professional titles that young doctors are worried about. In fact, on June 12 this year, the Opinions on Promoting the Sustainable, Healthy and Standardized Development of Social Medical Services issued by the National Health and Wellness Commission proposed that professional and technical personnel of social medical services participate in the evaluation of professional titles as well as professional and technical personnel of public medical institutions, and are not limited by the proportion of posts.
It is hoped that the hospital can establish a benign mechanism for doctors who are treated differently by the hospital because of "part-time" and "multi-point practice". At the same time, if doctors are allowed to do their job well, they can "part-time subsidize their families".
For surgeons, it is a bit difficult to open a clinic, but joining a "doctor group" and signing a contract with a big hospital is an effective channel for "flying knife" to be legal and compliant, and it may also be a part-time way more suitable for surgeons. Of course, we also need the support and understanding of the hospital, provided that we do our job well.
However, regardless of the above form, as long as the medical behavior is standardized and legal, it can meet the needs of patients, optimize the diagnosis and treatment structure, and promote the health of ordinary people, which is worth practicing. Huashang Daily reporter Grace Wai Wong
Source: Huashang. com-Huashang Daily